I'm worried about a friend. Over the past 10 years, he has had mental health problems. He suffered from paranoia at university and lived rough for a few years. He now has a flat and claims benefits. He hears voices and is convinced that a neighbour is breaking in when he's out and putting bleach in his shampoo and rearranging his things. He is miserable, angry and depressed. He seems to be getting worse. He has avoided medical help and is afraid of being drugged. I respect this and don't want to act behind his back, but I'm extremely concerned and could not forgive myself if he harmed himself or others. What should I do?

Maintain a dialogue

Continue to support him as this significantly increases his chance of a positive outcome, but get some support for yourself; try contacting Mind. Don't always assume everything he says is not true, though; talk to him about what is going on where he lives.

Maintain a dialogue about his experiences that helps you understand exactly what he thinks is going on and also helps him to challenge his beliefs about his situation. Ensure that he is informed about the choices open to him, including the pros and cons of neuroleptic medication and what it can do. Mind has a useful booklet called Making Sense of Anti-psychotics.

Don't let your relationship be all about his illness - encourage him in other parts of his life and help him find out about supported employment programmes through Jobcentre Plus. Find information about local initiatives, ask your local social services department and check at the library and in local newspapers.

If you really think he is a risk to himself or others, accept that there may come a time when you have to tell his GP, whether he likes it or not, or take whatever action you feel is necesssary. EC, Salford

Ease his torment

Please get medical help for your friend. My son is in his 20s and had very similar symptons. He was being tormented by all the effects of suffering from paranoid schizophrenia. I was repeatedly told by people who should have known better that it was up to him to go to the doctor for help, but part of the problem with the illness is that the sufferer does not recognise it. Eventually my husband went to the doctor with a list of all his problems and difficulties. Fortunately, he saw a sympathetic locum and we had to go through the heart-wrenching process of sectioning him.

Now, 16 months on, he is a changed person. Although he relies on his medication and I need to check he has taken it, he can now smile again and enjoy a joke. His recovery is still continuing slowly and we don't know what the future holds, but his misery and anger are no longer with us every day.

However guilty you may feel about going behind his back, think of the relief that he needs from the torment of his mental illness. His suffering is devastating for him as well as you, so please seek help for him and be prepared to be persistent enough to make sure he gets it. He may not thank you straightaway and there is a risk he may reject you for a while, but stay around as he needs a good friend.JG, via email

It needn't be drugs

There is help out there and it isn't necessarily tied to drugs - the Hearing Voices Network is nationwide and runs very successful peer support groups. The Mind information line and the Samaritans can help if you want to talk to someone about your concerns. If he can get to a calm, imaginative GP, there are primary care solutions on offer, such as cognitive behavioural therapy, exercise programmes and dietary advice. Explore gently, introducing him to day centre activities and find out whether he could get home help.

Your anxiety about his paranoia and him hurting himself or others is a valid one - ask a professional for advice to help you address it.PM, London

Try a self-help book

If your friend has some insight into his condition, you might suggest that he look at a recent self-help book on behavioural techniques for dealing with his problems: recommend Overcoming Paranoid and Suspicious Thoughts by Daniel and Jason Freeman and Philippa Garety (published by Robinson).Name and address withheld

My best friend is going out with my sister. I can't cope with the triangle that there is between me and them sometimes. My girlfriend and I feel we have to always justify our actions and decisions to them and my friend wants to carry on in the same way as before he was my sister's boyfriend. There are frequent misunderstandings over what we say or don't say to one another and I feel helpless - it seems to me that my friend is going out with my sister to get at me and to be above criticism. What can I do to live my own life without hurting my sister? Are there others trapped in this awkward situation?

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